title: Association of cardiac events with coronary artery disease detected by 64-slice or greater coronary CT angiography: a systematic review and meta-analysis.
abstract: BACKGROUND
  The value of ≥64-slice coronary CT angiography (CCTA) to determine odds of cardiac death or non-fatal myocardial infarction (MI) needs further clarification.
  
  
  METHODS
  We performed a systematic review and meta-analysis using publications reporting events/severity of coronary artery disease (CAD) in patients with suspected CAD undergoing CCTA. Patients were divided into: no CAD, non-obstructive CAD (maximal stenosis <50%), and obstructive CAD (≥50% stenosis). Odds ratios with 95% confidence intervals were calculated using a fixed or random effects model. Heterogeneity was assessed using the I(2) index.
  
  
  RESULTS
  We included thirty-two studies comprising 41,960 patients with 363 all-cause deaths (15.0%), 114 cardiac deaths (4.7%), 342 MI (14.2%), 69 unstable angina (2.8%), and 1527 late revascularizations (63.2%) over 1.96 (SD 0.77) years of follow-up. Cardiac death or MI occurred in 0.04% without, 1.29% with non-obstructive, and 6.53% with obstructive CAD. OR for cardiac death or MI was: 14.92 (95% CI, 6.78 to 32.85) for obstructive CAD, 6.41 (95% CI, 2.44 to 16.84) for non-obstructive CAD versus no CAD, and 3.19 (95% CI, 2.29 to 4.45) for non-obstructive versus obstructive CAD and 6.56 (95% CI, 3.07 to 14.02) for no versus any CAD. Similar trends were noted for all-cause mortality and composite major adverse cardiovascular events.
  
  
  CONCLUSIONS
  Increasing CAD severity detected by CCTA is associated with cardiac death or MI, all-cause mortality, and composite major adverse cardiovascular events. Absence of CAD is associated with very low odds of major adverse events, but non-obstructive disease significantly increases odds of cardiac adverse events in this follow-up period.
authors.affiliation: Division of Cardiology, Department of Medicine, University of Florida College of Medicine, Jacksonville, Jacksonville, FL, United States.
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Habib
authors.forename: Jacinta
authors.initials: J
authors.lastname: Green
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Butterfield
authors.forename: Gretchen M
authors.initials: GM
authors.lastname: Kuntz
authors.forename: Raguveer
authors.initials: R
authors.lastname: Murthy
authors.forename: Dale F
authors.initials: DF
authors.lastname: Kraemer
authors.forename: Robert F
authors.initials: RF
authors.lastname: Percy
authors.forename: Alan B
authors.initials: AB
authors.lastname: Miller
authors.forename: Joel A
authors.initials: JA
authors.lastname: Strom
mesh_terms: D017023:Coronary Angiography / Q000592:standards*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality; D003643:Death; D006801:Humans; D011446:Prospective Studies; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000592:standards*
keywords: CAD; CCTA; CHD; Cardiovascular events; Coronary CT angiography; Coronary artery disease; MACE; MI; Meta-analysis; SPECT; coronary CT angiography; coronary artery disease; coronary heart disease; major adverse cardiovascular events; myocardial infarction; single-photon emission computed tomography